Manager, Revenue Integrity

JOB PURPOSE

Under the general direction and guidance of the Director, Revenue Integrity, the Manager of Revenue Integrity is responsible for direct oversight of the day-to-day operations of Charge Description Master (CDM) management and charge integrity including, but not limited to charge capture, charge entry, charge reconciliation, and documentation improvement to maximization of revenue and ensures regulatory compliance. Responsible for developing workflows for facility revenue charge capture. Reviews and makes recommendation for all aspects of the hospital CDM. Collaborates with the Revenue Integrity Director to serve as a technical expert on CDM and charge capture for all service lines across the system. Direct oversight of Senior Revenue Integrity Analysts, Revenue Integrity Analysts, and OP IV Service Charge Analysts.

QUALIFICATIONS

All job qualifications listed indicate the minimum level necessary to perform this job proficiently.

LEVEL OF EDUCATION

Minimum: Bachelor's degree from an accredited college or university in a related field or related experience on a year-for-year basis.

Preferred:

CERTIFICATIONS, LICENSES, REGISTRATIONS

Minimum: One or more of the following: CPC, CPC-P, CPC-H, RHIT, RHIA, CCS,

Preferred: Certification in Auditing, Healthcare Compliance, or Certified Revenue Integrity Professional (CRIP).

TECHNICAL REQUIREMENTS

Minimum: Knowledge of various spreadsheet applications. Knowledge of billing requirements related to charges and associated claim forms. Knowledge of cost accounting concepts, principles, and computer applications. Knowledge of various hospital and professional fee coding systems including ICD10-CM, CPT and HCPCS. Knowledge of the content, structure and maintenance of the Charge master and fee schedule/ Possess strong understanding of various reimbursement methodologies with expert knowledge of all payer billing requirements.

Preferred: Knowledge of defense audits, insurance, registration, and billing requirements. Knowledge of acute care financial challenges, constraints, and best practice implementation methods. Skill in staff management with the ability to determine deficiencies and develop training and guidance to create efficiencies.

YEARS OF RELATED WORK EXPERIENCE

Minimum: Five plus years of progressive experience in revenue cycle areas, including three years of broad-based healthcare financial management and/or three years of charge-master, billing and reimbursement concepts experience. Three year of outpatient coding experience. Previous healthcare financial analysis and/or cost accounting experience. Three years of previous management and supervisory experience.

Preferred: